鼻尖的类型和手术设计

目的探讨适合国人的鼻尖分类体系,并设计相应的手术方案。方法根据鼻的形态差异,将鼻尖分为5型,即前伸型、后缩型、低垂型、肥大型和混合型,综合应用切除、缝合和填充移植物的手术方法行鼻尖修整术,并对手术效果进行评价。结果本组1028例患者,术后鼻孔不对称10例,7例经再次手术后满意;线结反应3例;移植物从切口突出1例。随访973例患者3周至7年,效果满意。结论鼻尖分类体系能够指导手术设计和操作,并获得稳定、满意的手术效果。     

自体肋软骨雕刻“元宝”样鼻尖移植物的临床应用

目的观察将肋软骨雕刻成"元宝"样作为鼻尖移植物行鼻尖成形术的临床应用及疗效。方法自2017年8月至2019年12月,上海联合丽格医疗美容门诊部对鼻尖形态欠佳的310例患者行"元宝"样肋软骨鼻尖整形手术。术中将肋软骨雕刻成"元宝"样联合软组织移植行鼻尖整形术,矫正鼻尖低、鼻尖肥大及鼻综合术后"夹捏"样畸形等。术后观察鼻尖高度、宽度等变化,评价术后效果。结果所有患者术后获随访5～24个月,平均8.4个月,鼻尖高度明显提升,鼻头明显缩小。早期3例出现"元宝"样移植物移位,经手术调整后效果满意;3例出现鼻部感染,将假体取出后治愈;2例自觉鼻尖过高,2例鼻尖软骨显形,经手术调整后,形态较满意。其余患者对术后效果均满意,总满意率为96.77%。结论将肋软骨雕刻成"元宝"样联合软组织移植行鼻尖整形术,重塑的鼻尖形态效果满意,值得临床推广应用。     

大型帽状移植物在自体肋软骨鼻整形术中的应用

目的探讨大型帽状移植物对鼻尖塑形的效果。方法切取的自体肋软骨于术中首先构建下方软骨支架,将半球形大型帽状移植物固定于鼻尖合适位置,与两侧大翼软骨缝合。分别植入鼻背移植物及盾形移植物,形成稳定鼻支架。结果本组134例患者术后鼻部形态得到了不同程度改善,鼻背抬高延长效果满意,鼻尖形态良好。供区并发症发生率为7.5%,包括胸膜破裂、瘢痕增生;受区并发症发生率为13.4%,其中移植物明显变形7例,软骨外露4例,感染4例,移植物明显移位3例。结论在鼻部整形术中鼻尖部使用大型帽状自体肋软骨移植物,因其雕刻相对简单,术后鼻尖形态圆润,植入的软骨不易显形且具一定活动性。在鼻部初次整形或修复手术中均可应用。     

耳软骨构建固定型鼻小柱支撑移植物在鼻尖成形术中的应用

目的探讨耳软骨构建固定型鼻小柱支撑移植物在鼻尖成形术中的应用效果。方法对30例自觉鼻部外形欠佳的求美者,行常规开放入路鼻整形术,采用耳软骨构建固定型鼻小柱支撑移植物作为鼻尖支架,再结合鼻背移植物进行隆鼻术。术后随访观察是否出现相关并发症,并对术后鼻部美学效果进行评价。结果本组30例求美者获随访3～9个月,均未出现相关并发症。鼻部美学效果评价:26例满意或较满意;4例欠满意,其中2例出现鼻小柱偏斜,1例出现轻微鼻背偏斜,1例对鼻尖凸出度不满意。结论采用耳软骨构建固定型鼻小柱支撑重塑鼻尖,可改善美学缺陷的鼻尖外形,操作简单、求美者术后恢复较快。     

自体肋软骨移植综合鼻成形术

目的探讨应用自体肋软骨移植行综合鼻成形术的方法,观察手术效果。方法鼻部应用开放切口．取自体肋软骨移植行综合鼻成形术。截取6～7cm长第6或7肋软骨用于结构移植：（1）雕刻成柳叶形鼻背移植物用于隆鼻术;（2）雕刻成长条形鼻小柱支撑移植物用于鼻小柱支撑及鼻延伸术;（3）雕刻成盾牌形移植物用于鼻尖成形术。结果52例患者均获得满意的鼻背及鼻尖美学效果。鼻背轮廓线、鼻尖表现点、鼻尖上区转折清晰。无移植物外露、移位、软骨变形。亦未见气胸、感染、血肿等并发症发生,胸壁瘢痕不明显,效果满意。结论应用自体肋软骨移植行综合鼻成形术,可以满足对假体存在心理排斥的患者的求美需求,亦可为二次或多次鼻成形术后畸形的患者提供足够的自体修复材料,并大大的降低了再次手术感染的风险。其效果良好,并发症少,值得推广。     

鼻小柱支撑移植物在鼻尖整形中的作用

目的：探讨鼻小柱支撑移植物在鼻尖整形中的分类、材料组成,作用及使用方法。方法：70例鼻尖整形病人中,均使用鼻小柱支撑移植物,其中使用鼻中隔软骨48例,肋软骨19例,耳甲腔软骨3例;使用漂浮/固定型移植58例,固定型移植4例,延伸型移植18例。结果：除1例出现了鼻尖突出度不足,经二次手术纠正外,余69例鼻尖成形良好,病人对手术效果满意。结论：根据不同情况,选择不同种类,不同材料进行鼻小柱支撑移植是鼻尖整形中一项良好的手术技术。     

以鼻中隔软骨为鼻小柱支撑移植物在鼻尖整形中的应用

目的:探讨以鼻中隔软骨为鼻小柱支撑移植物在东方人鼻尖整形中的应用。方法:在50例鼻尖整形患者中,均以鼻中隔软骨为鼻小柱支撑移植物,使用固定悬浮型移植27例,延伸型移植13例,鼻中隔延伸型移植10例。结果:除1例因术后鼻尖突出度不足,经二次手术纠正外,余49例鼻尖成形良好,患者对手术效果满意。结论:根据不同情况,以鼻中隔软骨的不同植入形式进行鼻小柱支撑移植是鼻尖整形中一项良好的手术技术。     

埋没导引缝合法矫治鹰钩鼻鼻尖畸形

目的介绍一种较新的矫治鹰钩鼻鼻尖畸形的手术方法。方法自1995年2月至2005年5月,采用埋没导引缝合技术对18例鹰钩鼻鼻尖畸形患者进行手术矫治,术后结合鼻管支撑的鼻孔悬吊法外固定7~10d。结果术后经14个月至3年的随访,18例患者的鼻尖外形良好,形态满意。其中1例患者因鼻腔内悬吊线穿透引起轻度炎症,术后3周剪除缝线,5d自愈。结论采用埋没导引缝合的手术方法对鹰钩鼻鼻尖畸形患者进行矫治,并结合缝合、悬吊和固定,获得了良好的术后效果。此方法是一种较理想的手术方法,值得推广应用。     

埋没导引缝合法矫治鹰钩鼻鼻尖畸形

目的介绍一种较新的矫治鹰钩鼻鼻尖畸形的手术方法.方法自1995年2月至2005年5月,采用埋没导引缝合技术对18例鹰钩鼻鼻尖畸形患者进行手术矫治,术后结合鼻管支撑的鼻孔悬吊法外固定7～10 d.结果术后经14个月至3年的随访,18例患者的鼻尖外形良好,形态满意.其中1例患者因鼻腔内悬吊线穿透引起轻度炎症,术后3周剪除缝线,5 d自愈.结论采用埋没导引缝合的手术方法对鹰钩鼻鼻尖畸形患者进行矫治,并结合缝合、悬吊和固定,获得了良好的术后效果.此方法是一种较理想的手术方法,值得推广应用.     

鼻整形术中应用膨体聚四氟乙烯治疗鼻尖低平

目的探讨膨体聚四氟乙烯（expanded pytetraflu-oroethylene，ePTFE）在隆鼻术中治疗鼻尖过低、鼻孔显露的手术方法，以减少传统手术方法的并发症。方法取鼻正中蝶形切口加双侧鼻翼缘切口行ePTFE加强型补片隆鼻术及治疗鼻尖低平。结果应用ePTFE加强型补片为536例患者隆鼻术及治疗鼻尖低平术。术后随访3个月至6年，满意者533例，占99．4％，不满意3例，占0．6％，3例患者术后出现伤口感染，取出ePTFE假体，并于3个月后重新行ePTFE假体隆鼻术，效果满意。结论应用ePTFE在隆鼻术中治疗鼻尖过低、鼻孔显露，可以明显减少传统手术方法的并发症，术后效果理想。     

亚单位原则在鼻尖成形术中的应用

目的 介绍以亚单位原则指导鼻尖成形术的方法和经验。方法 将鼻尖分成鼻翼、软组织三角、尖部和鼻小柱等亚单位，根据各亚单位的形态结构特点，结合鼻尖的美学参数，判断受术者鼻尖外观的缺陷，据以设计3种手术方法：切除法、缝合法和移植法。结果 随访216例，手术满意率89％（192例），基本满意率9％（20例），不满意率2％（4例）。结论 亚单位原则指导鼻尖成形术，能获得准确、稳定和满意的手术效果。     

Management of the Long Nose: Review of Techniques for Nasal Tip Supporting Structures

The long nose with a “plunging” tip is a deformity that involves an inferiorly rotated nasal tip, leading to an increase in the length of the nose. The anatomic basis of the long nose with a plunging tip may be divided into two types. Type 1 presents a normal alar–cartilage complex inferiorly displaced by a long nasal septum and long upper lateral cartilages. Type 2 is caused by a dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. During the study period, the authors identified 60 patients with long noses and plunging tips. For 22 patients with type 1 long noses, the high septal incision technique was used in 12 cases and the step technique in 10 cases. The invagination procedure alone was used for 22 of 38 patients with type 2 plunging noses. Also, an extension graft with the invagination procedure was used for 6 patients, and a columellar strut graft was used for 10 patients. A high septal incision increased tip rotation without significantly changing the amount of tip projection. However, the step procedure, the invagination technique alone, septal extension graft with the invagination technique, and columellar strut grafts increased nasal tip rotation and projection. During the study period, 38 patients were identified as having a smiling deformity, which was improved using the authors’ modification procedure. On the basis of the results, the authors recommend that the appropriate treatment for each patient with a long nose and a plunging tip must be determined by preoperative and intraoperative examination findings with the patient at rest and while smiling.     

鼻中隔软骨在鼻尖整形中的应用

目的：探讨在鼻尖圆钝或低平整形中应用鼻中隔软骨的手术方法及效果。方法：本组35例患者均采用“开放式”切口。根据鼻尖情况,修剪过多软组织,切取鼻中隔软骨,构建鼻尖及鼻小柱软骨支架,以重塑鼻尖形态。结果：自2005年以来,用上述方法整复35例患者,经6个月～2年随访,除6例单纯行鼻尖圆钝整形的患者感鼻尖较低外,其余29例均感满意,效果稳定。结论：在鼻尖圆钝或低平整形中应用鼻中隔软骨可取得良好效果。     

Three dimensional laser scan assessment of the Oriental nose with a new classification of Oriental nasal types.

The Oriental nose, which has been broadly classified as mesorrhine, differs in anatomy and morphology from other racial groups. The objective of this study is to carry out anthropometric measurements in the nose region, in order to establish norms for the Oriental nose and also to identify the variations that might occur within this group. Knowledge of the unique shape, anatomy and dimensions of the Oriental nose would be very useful for surgeons undertaking repair and reconstruction of Oriental noses. Ninety, normal Oriental subjects were scanned using a laser surface scanner, and the assessments were then carried out on the laser scan images. The 3-D laser scan images permit adjustment and positioning to achieve the correct standard views for assessment. Subjective assessment of the nose shape, as well as linear and angular measurements were carried out. Depending on the fullness and roundness of the nasal tip and the prominence of the alar lobules on either side, the Oriental nasal base may take on varied shapes and accordingly, three distinct shapes have been identified. They have been classified into types A, B and C where type A has a very prominent alar lobule and a full and rounded nasal tip. In type B, the alar lobule was less prominent and the nasal tip was more defined while in type C the alar lobule was the least prominent resulting in the lateral walls forming a relatively straight slope from the tip to the alar base. The linear and angular measurements for Oriental noses were also obtained and compared to values for other racial groups. The proportion indices for the Oriental nose showed that it was broader in relation to the nose height, and had less tip protrusion in relation to both the height and width of the nose. The data collected from this study can be used as norms for Oriental cases and the simple classification of the nose shape will serve as a guide for quick reference, when planning aesthetic or reconstructive rhinoplasties for the Oriental patient.     

Primary Nasal Tip Surgery: A Conservative Approach

Background

Rhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures.

Methods

For 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1?year.

Results

The results at 1?year showed high rates of improvement in tip definition (mean, 7.9?±?2.4) and nasal tip only evaluation (mean, 6.5?±?3.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2?±?3.2), nostril symmetry (mean, 4.5?±?4.1), and tip projection (mean, 5.8?±?2.9).

Conclusions

This simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips.     

改良Mohler法同期修复单侧唇裂鼻畸形

目的 探讨先天性单侧唇裂鼻畸形同期修复的手术方法,并对治疗效果进行评估.方法 采用改良的Mohler法修复唇裂,同期行鼻畸形的整复,术后6d开始佩带鼻部保持器至少半年,分别在术后3、12个月复诊.结果 1998年9月至2008年8月,共治疗103例,手术年龄为2.5～12个月.术后3个月随诊时,97例获得了良好的鼻唇形态,手术切口瘢痕不明显,与非裂隙侧人中嵴对称,双唇峰等高,双侧鼻孔对称,鼻小柱居中,鼻尖挺立,鼻翼塌陷不明显;6例鼻部形态满意,但存在裂隙侧唇峰上移,唇高不足.术后12个月随诊的89例鼻畸形并无明显加重,鼻软骨发育也未受到很大影响,存在唇高不足的3例上唇缩短也得到明显改善.结论 改良Mohler法同期修复单侧唇裂鼻畸形是一种值得推广的手术方式.     

鼻尖突出不足合并鼻指数过大的鼻型特点及联合治疗

目的 应用人体测量学以比例关系描述特定鼻型,探讨鼻尖突出不足合并鼻指数过大的鼻型特点及治疗方法,为鼻整形定量研究提供思路.方法 2010年3月至2011年10月,测量27例鼻尖低平、鼻翼肥大的青年女性鼻形态并计算指数值.患者均行隆鼻、鼻尖抬高并前延、鼻翼缩小三项鼻整形术.结果 随访3～12个月,效果满意.术后鼻指数、鼻宽深指数、鼻尖突出度均在正常范围内,其中部分患者比例值达到美学范围.结论 外鼻形态测量比例值能较客观、准确地描述某种鼻型.我国汉族青年女性,鼻指数大于82.05％,鼻尖突出度小于37.50％,可归类为鼻尖突出不足合并鼻指数过大鼻型,此类鼻型应用三项手术综合治疗,协调各亚单位比例,可塑造和谐美观的鼻型.     

隆鼻术后鼻端形态不佳的修整方法探讨

目的 探讨隆鼻术后鼻端形态不佳的原因和处理方法。方法 对隆鼻术后鼻端形态不佳的鼻尖前凸、鼻尖圆钝、鼻尖低平、鼻孔外翻和两侧不对称等，采用更换或重新雕琢假体、重塑鼻的软骨支架、充填自体软骨和推进皮瓣等方法，对116例受术者进行了鼻端修整术。结果 经过1个月至5年的随访观察，除3例肿胀消退时间较长，2例线结反应外，其余受术者均获得了满意的手术效果。结论 熟练掌握鼻假体雕琢技术以及合理应用鼻端修整的手术方法，调整鼻的软骨支架和皮肤瓣的位置，是获得满意手术效果的基础。